OPHTE# Al -5-- Z& Harnett County Department of Public Health
PERMIT # z f / Operation Permit 2 2 2 7 5
D /New Installation - Septic Tank L/ Nitrification Line ❑ Re air ❑ Expansion
PROPERTY LOCATION: ~ Z~
Name: (owner) SUBDIVISION LOT #
System Installer: .T --0 WA Registration #
Basement with plumbing: ❑ Garage lyly, /~umber of Bedrooms -3
Type of Water Supply: ❑ Community LJ Public ❑ Well Distance from well feet
System Type: Z !51b f ~VL TU-)Z) 5f,5 pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contactHealth Department 6 months prior to expiration for permit renewal.
[his system has been installed in compliance with applicable north Larollna (jeneral StatuteS, Wes for )ewage treatment and uisposai, and an conditions of the improvement rermn and Lonstrucnon nutnorization.
Z,,;; C 7`° 519 it 5
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew9e- dispos~al4stem on the above captioned proper ty.
Type of system: ❑ Conventional Y Other 0516! 0e; ZSVV- Septic gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch r feet ditches 3 feet ditches 1~0 inches
French Drain Required: Linear feet
Authorized State Agen Date ` 207 ~ ~